A randomized controlled trial of follow-up of patients discharged from the hospital following acute asthma - Best performed by specialist nurse or doctor?
A randomized controlled trial of follow-up of patients discharged from the hospital following acute asthma - Best performed by specialist nurse or doctor?
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DOI：
10.1016/s0012-3692(15)50952-5
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发表时间：
2006-07-01
期刊：
影响因子：
9.6
通讯作者：
Laroche, Clare M.
中科院分区：
文献类型：
--
作者：
Nathan, James A.;Pearce, Linda;Laroche, Clare M.
目的：评估与呼吸科医生相比，呼吸科专科护士是否能充分提供对近期因急性哮喘出院的患者的随访。设计：单中心、前瞻性、随机对照试验。设置：英国地区综合医院。参与者：从2000年10月至2003年10月，373例符合条件的急性哮喘患者中有154例入选本研究。所有> 16岁的患者都有资格参加这项研究。COPD患者被排除。干预：患者被随机分配到接受初始30分钟的后续门诊预约出院后2周内，无论是专科护士或呼吸科医生。这包括医疗审查，患者教育和自我管理哮喘计划。然后，相应的医生或护士在认为适当的情况下安排进一步的随访。所有患者被要求参加一个6个月的appointment.Measurements：主要结果是在6个月内入院恶化的数量。次要结果变量为峰值流量、生活质量（使用圣乔治呼吸问卷（SGRQ）和哮喘问卷20 [AQ 20]）和门诊出勤率的变化。结果：医生组66例患者和护士组70例患者的结果数据可用。护士组与医生组发生急性加重的患者数量无差异（45.6% vs 49.2%;比值比，0.86; 95%置信区间[CI]，0.44 - 1.71; p = 0.674）。然而，尽管医院门诊随访，两组中仍有相当比例的患者发生急性加重。生活质量没有差异（对于AQ 20，p = 0.285;平均差异，0.78; 95% CI，-0.64至2.19;和p = 0.891;平均差异，1.08; 95% C1，SGRQ为-5.05至7.21）或峰值流量变化（6个月时护士组和医生组之间的平均差异为1.39（95% CI，-3.84至6.63; p = 0.122）。由专科护士对急性哮喘患者进行后续护理，其安全性和有效性与医生相当。
Objective: To evaluate whether follow-up of patients recently discharged from the hospital as a result of acute asthma can be adequately provided by a respiratory specialist nurse compared to a respiratory doctor.Design: Single center, prospective, randomized controlled trial.Setting: District general hospital in the United Kingdom.Participants: One hundred fifty-four of 373 eligible patients admitted with acute asthma were enrolled into the study from October 2000 to October 2003. All patients > 16 years of age were eligible for the study. Patients with COPD were excluded.Intervention: Patients were randomly assigned to receive an initial 30-min follow-up clinic appointment within 2 weeks of hospital discharge with either a specialist nurse or respiratory doctor. This comprised a medical review, patient education, and a self-management asthma plan. Further follow-up was then arranged as was deemed appropriate by the corresponding doctor or nurse. All patients were asked to attend a 6-month appointment.Measurements: The primary outcome was the number of exacerbations within 6 months of hospital admission. Secondary outcome variables were change in peak flow, quality of life (using the St. George Respiratory Questionnaire (SGRQ) and the Asthma Questionnaire 20 [AQ20]), and clinic attendance.Results: Outcome data were available for 66 patients in the doctor group and 70 patients in the nurse group. There was no difference in the number of patients with exacerbations in the nurse group compared to the doctor group (45.6% vs 49.2%; odds ratio, 0.86; 95% confidence interval [CI], 0.44 to 1.71; p = 0.674). However, a significant proportion of patients in both groups had exacerbations despite hospital outpatient follow-up. There was no difference in quality of life (p = 0.285; mean difference, 0.78; 95% CI, -0.64 to 2.19 for the AQ20; and p = 0.891; mean difference, 1.08; 95% C1, -5.05 to 7.21 for SGRQ) or change in peak flow (mean difference between nurse and doctor groups, 1.39 (95% CI, -3.84 to 6.63; p = 0.122) at 6 months.Conclusions: Follow-up care by a nurse specialist for patients admitted with acute asthma can be delivered equivocally with comparable safety and effectiveness to that given by a doctor.